Tuesday, April 28, 2015

Adelphi University Center for Health Innovation Selected for a PCORI Pipeline to Proposal Award for Capacity and Partnership Building

Focused on Native American Health and Wellness: 
Reservation-Based Diabetes and Obesity Prevention

By Elizabeth Cohn 
Director of the Adelphi University Center for Health Innovation; primary investigator for the project

Native Americans develop diabetes at a rate of 33%--three times greater than Whites and twice that of African Americans. People of all races living with diabetes experience are two to four times greater risk of developing stroke, hypertension, kidney disease, dental and periodontal disease, and blindness. Recently, the members of the Unkechaug Nation have become increasingly concerned about the exponentially rising rate of diabetes on their reservation, as the numbers reflect the national trends. But a window of opportunity exists when lifestyle modifications can stop or significantly delay the progression of disease from pre-diabetes to diabetes type 2. These changes in diet and exercise are best initiated at the community–level, tailored so that they meet the needs of those who are using them.

To understand how to modify an existing set of evidence-based recommendations from the Centers for Disease Control and Prevention, a three-way collaboration has been developed between the Unkechaug Nation, Adelphi University Center for Health Innovation and Winthrop-University Hospital Diabetes and Obesity Institute. The Unkechaug Nation’s Initiative to End Diabetes (UNITED) collaborative proposes to:

(1) outline a set of partnership steps for a community-based effort focused on education and lifestyle modification

(2) explore and design infrastructure for community-engaged research on the reservation

(3) develop a governance structure that would support applications for future funding opportunities

(4) formulate metrics for a measurable outreach plan

(5) develop a guide for other reservations who wish to adapt pre-diabetes and diabetes prevention programs.

Co-investigator of the project is Harry B. Wallace, the chief of the Unkechaug Nation. Virginia Peragallo-Dittko, executive director of the Diabetes and Obesity Institute at Winthrop-University Hospital in Mineola to serve as a consultant.

Monday, April 27, 2015

Fixing Hospital Care is a Matter of Life or Death

by Bonnie Eissner

Running a hospital well or badly has life or death consequences. Wei Liu, Ph.D., and Susan Zori, D.N.P., know this all too well from their long experiences as hospital nurses and their more recent pursuits as academic researchers.

Prior to joining the Adelphi faculty as an assistant professor in the College of Nursing and Public Health, Dr. Liu worked for more than a decade as an emergency room nurse in China and Australia. Dr. Liu became fascinated by the complexities of how nurses, doctors and pharmacists communicate across their various disciplines in order to dispense medications.

What does it mean, for example, that doctors make medication decisions at the central staff station, away from patients’ bedsides? Or that they make their medical ward rounds when nurses are absent? What is the impact on patient care when doctors, nurses and pharmacists conduct separate staff meetings? 

Through interviews with and observations of doctors, pharmacists, nurses and patients, Dr. Liu documented patterns of communication and miscommunication in medication management at a major metropolitan hospital in Melbourne, Australia.

As a nurse in a separate ward at the hospital, Dr. Liu was able to establish credibility and rapport with the professionals and patients she was studying, to the point that they allowed her to videotape their clinical interactions.

Dr. Liu’s ultimate goal was to improve patient safety at the hospital. In addition to publishing papers based on her research, she took her findings back to the hospital professionals. In focus groups, she shared her data and a DVD she produced and encouraged discussion. Her aim, she said, was to “have them look at their own practices to see where the communication gaps might be and how we could improve our interdisciplinary communication and then improve our patient safety.”

Dr. Zori, a clinical assistant professor at Adelphi’s College of Nursing and Public Health, has practiced nursing for 40 years, many of them as a nursing director at prominent hospitals in New York City and on Long Island. During decades of overseeing teams of nurses, she grew curious about why some teams exuded positive energy and excelled while others seemed disgruntled and performed less well. She suspected that the nurse managers’ critical thinking abilities and attitudes played a significant role.

In an often-cited study of nurse managers and their staffs, Dr. Zori and her colleagues validated this hunch. Nurse managers who scored high in seven categories of critical thinking disposition, ranging from open-mindedness and inquisitiveness to truth seeking and cognitive maturity, had staffs who felt better about their work and, as a result, were more likely to provide safer and more effective patient care.

Dr. Zori has since been testing ways to boost the critical thinking skills of up-and-coming nurses. Working with administrators at North Shore LIJ Health System’s Center for Learning and Innovation, for example, she created a critical thinking class for nurses in the system’s fellowship program. From journals that the nurses kept, Dr. Zori observed that many had become more attuned to the importance of being inquisitive and analytical in their work.

In her classes at Adelphi, Dr. Zori encourages critical thinking by emphasizing case studies and interaction. “For me, it’s constantly challenging myself to find a way to get [students] to critically think and to be creative and interactive so that they’re not just learning information, they’re applying it to real-life situations,” she said. 

This article appeared in the Spring 2015 issue of Erudition.

Monday, April 20, 2015

Learning the Principles of Social Network Analysis (SNA) to Better Understand Mexican Migration

By Jacqueline Olvera 

When the Center for Health Innovation (CHI) announced its Summer Scholar Program in 2014, I jumped at the opportunity to apply. CHI made it possible for AU faculty to enroll in a variety of summer skill building courses and seminars offered at the Mailman School of Public Health at Columbia University.  Since I had been working on a project on Mexican migration, I was particularly interested in the Social Network Analysis (SNA) course. I had conducted in-depth interviews with migrants from Tlaxcala, Mexico with funding from the Russell Sage Foundation and was interested in finding out if network analysis would enrich my study. Based on preliminary analysis of these interviews, the data revealed that relationships between migrants were meaningful structures. That is, I was finding that social ties are how migrants find housing, jobs, and information about community resources. And equally as important, the formalized structures of these relationships seemed to be the basis for inclusion and exclusion when forming community. Given my interests in social relationships, I was delighted when I found out that I would indeed be able to enroll in the SNA course. 
The course I participated in provided an excellent introduction to the conceptual and computational principles of SNA. On our first day, we covered what Social Network Analysis is and is not, what counts as network data, and how to collect it.  We spent time using R, a language and platform for statistical computing and graphing in order to manipulate network matrices and visualize network data.  Thereafter, we quickly moved on to a discussion of ego-networks and the meaning of distance, density, and balance within an individual’s networks.  By day three, we covered higher-order network structures: the group and entire networks. All the while, we focused on important network structural features such as equivalence, clustering, centrality, and cohesion.  For example, in a migrant network computing centrality indices might tell us which individual in a network is the most central or popular.  
The fourth day of the course was by the best part – we put our knowledge to work by focusing on applications of SNA.  We explored examples from epidemiological research such as the transmission of AIDS, the structure of adolescent romantic and sexual networks, and the dynamics of smoking in large networks.  Each of these empirically motivated problems gave us a glimpse into how network analysis is applied.  More specifically, we focused on three network processes: Search, Diffusion, and Influence.  And, we replicated analyses of classic studies that examine how network ties facilitate the exchange of employment information as well as the efficiency of job search strategies in networks.

On the final day of the course, we covered statistical models and worked through tutorials in R.  The instructor introduced network autocorrelation and stochastic actor oriented (SIENA) models. Since I had experience with spatial analytic techniques, the network autocorrelation model was familiar. In a recently published paper, I used neighborhood-level data to estimate spatial lag models that follow similar autocorrelation properties.
After completing the course, I have spent much time thinking more about how I might use the insights of network analysis to ask, what network practices in the small migrant community I have been studying might tell us something about the raising and blurring ethnic boundaries? My hope is that by integrating social network analysis into my research I will make new inroads into the ways in which migrant communities come to make sense of the places they live and work in.

A New Approach to Mental Healthcare

by Bonnie Eissner

For too many people with mental illness, crisis medical care has become the norm—a trend that has a great personal and financial toll. In 2013, hospitalizations for Nassau County residents who received Medicaid mental health services cost the agency more than $35 million. The fact that many patients are rehospitalized within 30 days of discharge calls into question the effectiveness of this crisis approach to mental healthcare.

To address this issue, New York State is now working with physicians and health clinics to provide health homes for Medicaid recipients who suffer from chronic mental and physical illness. The health home concept is to offer an integrated system of care in which a patient’s needs—from scheduling medical appointments to providing transportation to those appointments to setting up social services—are coordinated by a small interdisciplinary team or an individual care manager.  

Central Nassau Guidance & Counseling Services, Inc., based in Hicksville, New York, is one agency that offers health home services. Last year, with funds from a New York State Innovation Fund grant, the agency established its Stability at Home pilot program to help Medicaid recipients with serious mental health conditions transition from hospitalization or haphazard community care into a more stable health home system of care.

Chrisann Newransky, Ph.D., an assistant professor at Adelphi’s School of Social Work, explained that a primary goal of this new approach is to facilitate the many healthcare responsibilities and tasks that seem routine to the rest of us. “If people stay connected to the system—they don’t drop out of the system—then they’re less likely in general to use emergency care, which we know is completely expensive and not all [that] effective,” she said.

After consulting with Adelphi’s Center for Nonprofit Leadership and its faculty director, Peter Chernack, Ph.D., Central Nassau Guidance & Counseling tapped Dr. Newransky, whose primary research interests are disease prevention and health disparities, to be the external evaluator of Stability at Home.

Dr. Newransky is advising on the best sources of data and approaches to data collection for evaluating the program’s effectiveness for the nearly 150 participants and their families. She is also conducting independent follow-up research with the participants and families.

“What’s unique about the [program] design is that different organizations are coming together,” she said, noting that the Long Island Crisis Center and Options for Community Living, Inc. are also involved in the project. This coming summer, Dr. Newransky plans to interview the leaders of the three organizations in order to document this model of interagency collaboration and understand what worked well and what improvements can be made.

This article appeared in the Spring 2015 edition of Erudition

Monday, April 13, 2015

Advancing the Science of Addiction and Trauma Recovery

by Bonnie Eissner

What is the relationship between early-life trauma and addiction? What treatments are most effective for people, particularly poor women and families who are struggling with these often-linked challenges? How can these treatments be implemented in community clinics?

These are questions that Denise Hien, Ph.D., a professor at the Gordon F. Derner Institute of Advanced Psychological Studies, has been seeking to answer throughout her career. A researcher, clinician and teacher, her overarching aim is to “understand how early-childhood abuse evolves over the course of life and intersects with substance use and other kinds of problems.”
Dr. Hien has noted that “as many as 80 percent of women seeking treatment for drug abuse report lifetime histories of sexual and/or physical assault.” Through her clinical work with women and families in New York City’s Harlem, Morningside Heights and Washington Heights neighborhoods, as well as her national research, Dr. Hien works to improve treatment outcomes for patients who struggle with trauma and substance abuse. 

Since 2002, Dr. Hien has been a co-principal investigator with the National Institute on Drug Abuse (NIDA) Clinical Trials Network Greater New York Node. The network is a federal initiative to link researchers and community-based treatment centers to allow real-world studies of drug treatments. In a recent NIDA-sponsored study, for example, Dr. Hien and her team examined what happened when an antidepressant medication was added to a cognitive behavioral therapy treatment for PTSD and alcohol use disorders. The researchers found that the drug combined with the therapy, known as Seeking Safety, was significantly more effective at treating PTSD and alcohol abuse than therapy alone.

“You might think, ‘Well isn’t that obvious? That’s what people do, they give [patients] medication and they give them therapy,” Dr. Hien said. “But nobody really knows if it works. So here’s a trial that showed that it really works.”

In another NIDA-sponsored project, Dr. Hien and her colleagues worked with drug counselors across the country to see if they could safely and effectively conduct trauma treatment groups with their clients. “The answer was yes they could, so it provided support for being able to translate treatment into the real world,” Dr. Hien said.

Having conducted numerous clinical trials, Dr. Hien is intimately familiar with their advantages as well as their shortcomings. “It’s hard to show big effects with relatively small sample sizes,” she pointed out, adding, “And then there’s the problem of ending up testing what amount to short-term treatments for long-term problems.”

How can these challenges be overcome? For Dr. Hien, the short answer is big data. She is now applying for a grant to create a large data set from more than 20 clinical trials that tested the efficacy of medication and psychotherapy in treating PTSD and substance use disorders. Dr. Hien explained that with information on thousands of patients, “you can ask questions that are more nuanced when it comes to trying to advance the science of treatment.”

Dr. Hien teaches master’s- and doctorate-level psychology courses at Adelphi and says that her work in the field amplifies what she can offer students in the classroom.

“My clinical work and my research inform my teaching because they’re what I’m passionate about, and usually I’m teaching things that link up to these topics,” she said. 

This article is from the spring 2015 issue of Erudition. 

Monday, April 6, 2015

CHI Rapid Response: Sports Concussion Symposium

by Sophia Conti

On Monday, March 30 Adelphi University’s Center for Health Innovation and Winthrop University Hospital hosted a Sports Concussion Symposium, a rapid response event designed to react to emergent health issues on Long Island. The event featured a variety of speakers and panelists, providing an overview of concussions and the importance of recognizing its symptoms.

Concussions are defined as a trauma-induced alteration in a person’s mental state, with physical, cognitive, emotional, or sleep-related symptoms. While higher-grade concussions tend to involve a loss of consciousness, not every concussion does. A single concussion can take weeks, months, or even years to heal completely.

“Every concussion is different,” said Dr. Kevin Curley, an attending physician at Winthrop University Hospital. “Each concussion can have varying combinations of symptoms.”

Multiple concussions can lead to detrimental long-term health problems, such as chronic traumatic encephalopathy (CTE) and traumatic brain injury. A concussion occurring before a previous one has completely healed can lead to second impact syndrome, a fatal brain herniation.

Among the panelists was Pat LaFontaine, National Hockey League Hall of Fame member, who attested to the severity of concussion symptoms. “All those symptoms are for real,” LaFontaine said. “I was lucky my brain found its way back and plugged itself back in.”

Several states, including New York, have legislated the return-to-play criteria for concussed athletes, which often prohibit students from playing on the same day as their head injury. Even the international community has created guidelines for a standardized concussion assessment.

Baseline testing for athletes in balance, cognition, and emotion is extremely important. After a hit to the head, the same tests can be conducted to more easily diagnose a concussion. Coaches, parents, and teachers are also crucial to concussion diagnosis, as they are most familiar with student athletes and may be able to more easily identify changes in behavior than a physician.  

“Sports provide many positive benefits to our children and young adults,” said Don Gronachan, vice president of physical medicine sales at Biodex Medical Systems, Inc. “But we are concerned about the short- and long-term safety of these young athletes.”

The CHI Rapid Response: Sports Concussion Symposium consisted of Emilia Zarco, Robert Otto, John Wygand, and John Petrizzo in the Ruth S. Ammon School of Education, Department of Exercise Science, Health Studies, Physical Education and Sport Management; and Daniel McCabe and Michael Gavagan in the Department of Athletics. 

Speakers and panelists at the CHI Sports Concussion Symposium
First row (from left): Michael Kennedy ’81, DO, MBA, director, Expert Medical Care; Elizabeth Gross Cohn, Ph.D., RN, director, Adelphi University Center for Health Innovation; Gayle Insler, Ph.D., provost and senior vice president of academic affairs, Adelphi University; Emilia Zarco, MD, MEd, chair of the Department of Exercise Science, Health Studies, Physical Education, and Sports Management, Adelphi University; Ann Cornell-Bell, Ph.D., vice president of administration, Perseus Science Group LLC; Don Gronachan, MA ’83, vice president of physical medicine sales, Biodex Medical Systems, Inc. Second row (from left): Kevin Curley, MD, Winthrop University Hospital; Rupi Johal, MD, Winthrop Orthopaedic Associates; Mark Grossman, MD, team physician for Adelphi Athletics; Pat LaFontaine, NHL Hall of Fame and founder, Companions in Courage Foundation; Javan Esfaniari, M.Sc., chief scientist and technology officer, Chembio Diagnostic Systems, Inc.